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Volunteer/Intern Interest Form
Name
First Name
Last Name
2. I am interested in
*
Volunteering
Internship Opportunity
AmeriCorps
3. I am seeking volunteer hours for
*
Work
School
Leisure
4. Do you have a set goal of how many volunteer/internship hours you would like to earn? If yes, how many hours? If no, write n/a.
*
5. Do you have a deadline to complete your volunteer/internship hours? If yes, provide date. If no, write n/a.
*
6. DOB (Must be at least 16 years of age)
*
-
Month
-
Day
Year
Date
7. Gender
*
Male
Female
Non-binary
Prefer not to disclose
8. Street Address
*
9. City
*
10. Zip Code
*
11. Email
*
Confirmation Email
example@example.com
12. Mobile Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
14. Preferred Method of Contact
*
Cell Phone (Calls, No Texts)
Email
15. T-Shirt Size
*
XS
S
M
L
XL
XXL
Other
16. Emergency Contact Name, Relation, and Phone Number
*
17. Name of School or Employer. If neither, write n/a.
*
18. Languages Spoken
*
Creole
English
French
Spanish
Other
19. Preferred Program/Event/Activity to Volunteer for? Please select all that apply. Please note that certain programs and activities require specific clearances.
*
Administration & Special Events
Youth Programs
Senior Nutrition
Other
21. Do you have reliable transportation?
*
Yes
No
22. Preferred County to Serve/Volunteer in? Please select all that apply.
*
Broward
Miami-Dade
West-Palm Beach
23. How many miles are you willing to travel to volunteer?
*
24. Are you looking to complete service hours due to a court order? Unfortunately, we DO NOT offer volunteer hours for court ordered community service.
*
Yes
No
25. Have you ever been arrested or convicted of a crime? A "yes" response will not automatically disqualify you from being considered.
*
Yes
No
If you responded "yes", please provide details below. If not applicable, write n/a.
*
27. Availability. Please select all that apply.
*
Special Events, Programs, or Activities Only
Monday - Morning
Monday - Midday/Afternoon
Tuesday - Morning
Tuesday - Midday/Afternoon
Wednesday - Morning
Wednesday - Midday/Afternoon
Thursday - Morning
Thursday - Midday/Afternoon
Friday - Morning
Friday - Midday/Afternoon
Other
28. Where did you hear about us? Please specify Social Media Site or Referral Source in the "other" blank section which permits typing.
*
FLIPANY Website
Referral
Social Media
HandsOnBroward.org
VolunteerFlorida.org
VolunteerMatch.org
Other
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29. To the best of my knowledge, I certify that all statements made in this application are true, complete, and correct to the best of my knowledge and I understand that any falsification or misrepresentation of facts will result in disqualification or dismissal.
*
I agree
I disagree
30. Signature - By signing below, I acknowledge that my typed signature serves as a legally binding substitute for my handwritten signature.
*
31. Today's Date
*
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Month
/
Day
Year
Date
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